title: Zero ischemia robotic partial nephrectomy: sequential preplaced suture renorrhaphy technique.
abstract: OBJECTIVE
  To describe a robotic partial nephrectomy (PN) technique that eliminates renal global ischemia while decreasing parenchymal bleeding.
  
  
  METHODS
  Before tumor resection, a suture is placed through the parenchyma adjacent to the tumor and deep to the planned edge of resection. The tumor resection is begun between the tumor edge and the preplaced suture and continued along the excision margin until some bleeding is encountered. A second suture is placed into the already excised parenchyma. This is repeated until the mass is completely excised, while suturing the parenchyma simultaneously.
  
  
  RESULTS
  Fourteen patients underwent this technique between April 2008 and January 2013 by a single surgeon. Median age was 66 years and 64.3% (N = 9) were men. Median body mass index (BMI) was 27.5 Kg/m(2). Median radius, endophytic, nearness to collecting system, anterior/posterior, and location (RENAL) nephrometry score was 6.5. Median tumor size excised off clamp was 2.2 cm. Three patients had multiple tumors; 2 having a warm ischemia time (WIT) of 14.5 and 15 minutes. Median estimated blood loss (EBL) was 192.5 mL. Median operative time was 160 minutes. There were no Clavien grade 3 or 4 complications. One patient had a postoperative ileus and 1 patient had a blood transfusion and deep vein thrombosis. One patient had a positive tumor parenchymal margin, but negative excisional bed margin. Median hospital stay was 3 days and median follow-up was 8.4 months.
  
  
  CONCLUSIONS
  Sequential preplaced suture renorrhaphy technique is a safe and effective technique that may be useful in renal function preservation by limiting or eliminating WIT while aiding in maximizing nephron preservation, especially in those patients with solitary kidneys and multiple tumors.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Emad R
authors.initials: ER
authors.lastname: Rizkala
authors.forename: Ali
authors.initials: A
authors.lastname: Khalifeh
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Dinesh
authors.initials: D
authors.lastname: Samarasekera
authors.forename: Humberto
authors.initials: H
authors.lastname: Laydner
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007511:Ischemia / Q000517:prevention & control; D007680:Kidney Neoplasms / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D059351:Organ Sparing Treatments; D012371:Robotics; D013536:Suture Techniques; D052096:Warm Ischemia